Original article
Experimental endoscopy
Endoscopic full-thickness resection and defect closure in the colon

https://doi.org/10.1016/j.gie.2009.12.056Get rights and content

Background

Endoscopic full-thickness resection (eFTR) is a minimally invasive method for en bloc resection of GI lesions.

Objective

The aim of this pilot study was to evaluate the feasibility of a grasp-and-snare technique for eFTR combined with an over-the-scope clip (OTSC) for defect closure.

Design

Nonsurvival animal study.

Setting

Animal laboratory.

Animals

Fourteen female domestic pigs.

Interventions

The eFTR was performed in porcine colons using a novel tissue anchor in combination with a standard monofilament snare and 14 mm OTSC. In the first group (n = 20), closure of the colonic defects with OTSC was attempted after the resection. In the second group (n = 8), an endoloop was used to secure the resection base before eFTR was performed.

Results

In the first group (n = 20), eFTR specimens ranged from 2.4 to 5.5 cm in diameter. Successful closure was achieved in 9 out of 20 cases. Mean burst pressure for OTSC closure was 29.2 mm Hg (range, 2-90; SD, 29.92). Injury to adjacent organs occurred in 3 cases. Lumen obstruction due to the OTSC closure occurred in 3 cases. In the second group (n = 8), the diameter of specimens ranged from 1.2 to 2.2 cm. Complete closure was achieved in all cases, with a mean burst pressure of 76.6 mm Hg (range, 35-120; SD, 31). Lumen obstruction due to the endoloop closure occurred in one case. No other complications or injuries were observed in the second group.

Limitations

Nonsurvival setting.

Conclusions

Colonic eFTR using the grasp-and-snare technique is feasible in an animal model. Ligation of the resection base with an endoloop before eFTR seems to reduce complication rates and improve closure success and leak test results despite yielding smaller specimens.

Section snippets

Animals and preoperative preparation

The study was conducted at the animal facility in Beichlingen, Thüringen, Germany, after approval of the Animal Care and Use Committee. Fourteen female domestic pigs with a mean weight of 28.1 kg (range 20-36 kg, SD 5.0) were used. The animals were fasted from solid food for 48 hours before surgery, but were allowed full access to water and milk. Preanesthesia sedation consisted of ketamine 2 mg/kg and xylazine 2 mg/kg. General anesthesia was achieved using isoflurane, nitrous oxide (N2O), and O

Results for eFTR with secondary OTSC closure

Twenty eFTRs were performed in 10 animals without prior placement of an endoloop. Outcomes are provided in Table 1.

The eFTRs produced complete colonic wall defects in all cases. Adequate closure of eFTR defects (size 2.4-5.5 cm) was successful in 9 out of 20 cases (45%). Defects ranging from 2.4 to 2.7 cm were successfully repaired in 5 out of 6 cases (83%), and the largest resections that left defects ranging from 2.9 to 5.5 cm were adequately closed in 4 out of 14 cases (29%). In 5 cases

Discussion

This pilot study demonstrates several strengths and weaknesses of eFTR in combination with OTSC closure. The grasp-and-snare technique is very straightforward and resulted in specimens up to 5.5 cm in size. These results are in accordance with an earlier report using a similar technique for gastric eFTR.22 The tissue anchor can be easily deployed in the middle of any targeted resection area and allows for reliable tissue anchoring, pseudopolyp creation, and full-thickness resection.

The most

References (34)

  • G.S. Raju et al.

    Endoluminal suturing may overcome the limitations of clip closure of a gaping wide colon perforation (with videos)

    Gastrointest Endosc

    (2007)
  • G.S. Raju et al.

    Endoluminal clip closure of a circular full-thickness colon resection in a porcine model (with videos)

    Gastrointest Endosc

    (2007)
  • G.S. Raju et al.

    Controlled trial of immediate endoluminal closure of colon perforations in a porcine model by use of a novel clip device (with videos)

    Gastrointest Endosc

    (2006)
  • G.S. Raju et al.

    Endoscopic closure of colon perforation compared to surgery in a porcine model: a randomized controlled trial (with videos)

    Gastrointest Endosc

    (2008)
  • D. von Renteln et al.

    Gastric full-thickness suturing during EMR and for treatment of gastric-wall defects (with video)

    Gastrointest Endosc

    (2008)
  • P.F.L. Deyhle et al.

    A method for endoscopic electroresection of sessile colonic polyps

    Endoscopy

    (1973)
  • W.I. Wolff et al.

    A new approach to the management of colonic polyps

    Adv Surg

    (1973)
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    DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. (Research support for this study was provided by Ovesco Endoscopy and Olympus Germany.)

    If you want to chat with an author of this article, you may contact Dr. von Renteln at [email protected]

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